What Is A Migraine Cocktail: ER And At Home

What is a Migraine Cocktail?

A migraine cocktail is a combination of medications and treatments used to treat severe migraine attack symptoms. Migraine cocktails can be done at home, in an outpatient center, an emergency department (ED), or when someone is admitted to a hospital for treatment of migraine. Knowing what is a migraine cocktail can help you make better-informed medical decisions. If you are experiencing a severe migraine attack and are not finding relief from your usual treatments, you may want to visit the hospital. But first off, what is migraine?

What is Migraine?

Migraine is a neurological disease associated with headaches that can cause severe throbbing pain or a pulsing sensation, usually on one side of the head. It’s often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. You may want to find out if you are experiencing these common migraine symptoms to know if you suffer from migraine.

What is in a Migraine Cocktail?

Migraine cocktail ingredients include a combination of medications and treatments to help relieve pain from the migraine attack. If you go to the emergency department with a migraine attack, you may receive migraine cocktail IV. Migraine cocktail ingredients can consist of:

1. Non-steroidal anti-inflammatory drugs (NSAIDs) (Advil)
2. Acetaminophen (Tylenol)
3. Magnesium
4. Medications to reduce nausea or vomiting
5. Diphenhydramine (Benadryl) to help aid with potential allergies
6. Dihydroergotamine or IV fluids to also aid with hydration
7. Dexamethasone: This medication is a type of steroid and reduces inflammation in the body. Research suggests dexamethasone may help prevent migraine from coming back after initial treatment.

If your migraine attack isn’t responding to your typical medications or OTC medicine or if the migraine attack lasts over 72 hours, it might be time to consider a migraine cocktail. Knowing what is in a migraine cocktail can help you identify potential allergies you may have.

Migraine Cocktails At Home With Benadryl

Benadryl is a common migraine cocktail ingredient. It is used as a supplement to reduce the potential allergies or side effects associated with other migraine cocktail ingredients. Your doctor may prescribe benadryl as a form of acute migraine medication. Interestingly, while migraine cocktails at home with Benadryl might be commonly used, research has shown that intravenous diphenhydramine (benadryl) did not improve the intensity of acute migraine attacks in an ER or ED setting. This is surprising given that anti-histamines like Benadryl are commonly used in migraine cocktails in ER or ED for acute migraine attack treatments. While you can try making migraine cocktails at home with benadryl, do note that your body will develop a tolerance towards it. Also, you will experience drowziness when you consume benadryl but this will go away in approximately on the 4th day.

When is it time to visit the emergency room (ER)?

If your typical medical treatments are not working and your migraine attack lasts more than 3 days, you should consider visiting urgent care or the emergency room (ER) to help alleviate the migraine attack symptoms. It’s also typical to go to the hospital for treatments if it’s your first time experiencing a migraine attack or migraine aura. 

During your hospital visit, doctors may want to rule out any other possibilities of neural conditions such as a stroke so be sure to communicate all of your symptoms to get an accurate diagnosis and treatment for migraine. After the nurse practitioner or physician assistant checks in with you, a nurse will administer medications. 

If the migraine cocktail you receive stops your migraine attack, it’s important to keep note of what worked for future reference. 

Migraine Cocktails In Emergency Room (ER) or Emergency Departments

Migraine cocktails can also be used in the ER (also known as emergency room/emergency departments). Ingredients of migraine cocktails in ER include nonsteroidal anti-inflammatory drugs, antiemetic medications, diphenhydramine, dexamethasone, and intravenous fluids. Sometimes, migraine cocktails in ER consist of opioids but this is only a last-resort treatment option for acute migraine attacks after all other forms of migraine cocktails are used. The effectiveness of migraine cocktails in ER is known to be positive. Research has shown that these treatments and migraine medications are more effective when they are given all at once in a migraine cocktail, rather than being given in stages throughout the ER visit. Here is a common list of migraine cocktails in ER:

• NSAIDs, such as Ketorolac: The recommended ketorolac dosage is a 60-mg intramuscular dose or 30-mg intramuscular or intravenous (IV) doses every 6 hours (maximum daily dose of 120 mg)
• Acetaminophen is a common ingredient for migraine cocktails in ER. It is good for migraine patients who have not taken acetaminophen in the last 4 hours and have very minor migraine attacks
• Triptans: Serotonin 1B or 1D agonists are often used in outpatient setting. Triptans have contraindications, and may not be effective as an ingredient of a migraine cocktail in ER setting.

Often, migraine cocktail IV ingredients include the above. Common migraine cocktail IV ingredients include NSAIDs like Ketorolac, prochlorperazine, diphenhydramine, dexamethasone and saline solution.

Ultimately, hospital migraine cocktails are administered for more severe migraine attack symptoms.

Making Over The Counter (OTC) Migraine Cocktails At Home

If you find that your migraine attack is not severe enough to visit the hospital, you might consider an over-the-counter migraine cocktail or an OTC migraine cocktail at home. Homemade migraine cocktails ingredients consist of:

• Acetaminophen, 250 milligrams (mg)Trusted Source
• Aspirin, 250 mg
• Caffeine, 65 mg

That being said, you should consult your physician before trying any homemade migraine cocktails with over the counter drugs. OTC migraine cocktails can cause side effects, the most common include headaches, dizziness, and drowsiness. The American Migraine Foundation recommends not using OTC medications too often, or they can cause medication overuse headaches. “Most OTC medicines are suspected of causing Medication Overuse Headache (MOH) if taken consistently for more than two days a week.” You can try taking a common migraine medication recommended by your doctor to assess the individual effects. For example, Excedrin is a common migraine medication for migraine patients. However, do note that these migraine cocktails might work differently as our bodies respond differently.

As mentioned earlier, the physician may prescribe other forms of migraine medications, such as CGRP inhibitors or CGRP blockers like Qulipta. There are other migraine medications, such as triptans that your doctor or neurologist may prescribe. Ultimately, if you’re at home, migraine cocktails are an alternative you can try with common medication, like Excedrin Migraine and so on.

Homemade Migraine Vitamin Cocktails

As the name suggests, migraine vitamin cocktails consist of a combination of various vitamins and supplements that are commonly used to help migraine patients cope with migraine. Here are some common migraine vitamin cocktail ingredients:

• Vitamin B12: Also known as riboflavin, Vitamin B12 may help reduce the frequency of migraines in people who are deficient in it. In a small study, people who took 400 mg of riboflavin daily for six months reported half the number of headaches per month compared to before and reduced their use of other medications. 
• Vitamin D: Vitamin D may also be helpful in reducing the frequency of migraines, although the exact mechanism is not clear. In a study, combining vitamin D3 and simvastatin, a cholesterol-lowering drug, reduced the number of migraines per month by an average of eight to nine in people who had four to 14 migraines per month. The recommended dose is 1,000 IU twice per day, and it is generally considered safe, although it can cause various side effects when taken in excess. 
• Magnesium: It is a mineral that is found in the body and in many foods, may be effective in reducing the frequency of migraines in people with low levels of magnesium. In a study, people who took 600 mg of magnesium daily for 12 weeks had a 41.6% reduction in the frequency of migraines during the last four weeks of the study and took fewer medications to treat their symptoms.

Ultimately, it is important to consult your migraine doctor or neurologist to assess the effectiveness of these homemade migraine cocktails, especially when you are making an OTC migraine cocktail at home. You can use a migraine diary, like Migraine Buddy to find patterns in the efficacy of the migraine cocktails.

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References

“Migraine Cocktails: What They Are and Why They Are Misunderstood.” American Migraine Foundation, 10 Feb. 2022, https://americanmigrainefoundation.org/resource-library/migraine-cocktail/. Accessed 27 Dec. 2022.

This article was contributed by Michelle Florero. Michelle is part of the Content Writing Team of #MBvolunteer, a volunteering initiative of Migraine Buddy. Michelle enjoys singing and hiking during her free time and uses Migraine Buddy to help manage migraine attacks. If you would like to contribute your writing or design expertise like Michelle, you can volunteer with Migraine Buddy here.